A powerful influence on the quality of care in intensive care units (ICUs) is the presence of critical care physicians (intensivists) in the unit. High-intensity intensivist staffing (required intensivist consultation or closed ICU where intensivists see all patients) is associated with a 29 percent reduction in hospital mortality and a 49 percent reduction in ICU mortality. However, only 10-15 percent of U.S. hospitals have high-intensity staffing by intensivists, primarily due to an existing and worsening shortage of intensivists. Telemedicine, a common form of health information technology, has been used to provide remote intensivist monitoring for ICUs via a tele-ICU. The only study of remote ICU monitoring with a tele-ICU found a reduction in mortality and length of stay comparable to on-site intensivist staffing. More research is needed because of limitations with this single study, the growing demand for intensivist coverage in ICUs, the shortage of intensivists, and the possible effectiveness of tele-ICUs. [unreadable] [unreadable] The specific aims of this study are: [unreadable] [unreadable] 1. To measure the effect of a tele-ICU on mortality, complications, and length of stay in ICUs in a tertiary care teaching hospital, and in seven community (including two "small") hospitals using a pre- and post-intervention study design. [unreadable] [unreadable] 2. To measure the cost-effectiveness of the tele-ICU. [unreadable] [unreadable] 3. To use human factors engineering techniques to determine how changes to the user interface of the tele-ICU may increase the value of the technology. [unreadable] [unreadable] 4. To measure changes in healthcare provider attitudes about teamwork and safety climate after implementation of the tele-ICU. [unreadable]